SAT0124 Aortic stiffness and time to wave reflection are associated with left ventricular diastolic dysfunction measures in rheumatoid arthritis

Abstract

Background
Patients with rheumatoid arthritis (RA) experience an increased frequency of heart failure with a preserved ejection fraction (HFpEF) (1). The treatment of HFpEF is currently suboptimal. Elucidation of the underlying pathophysiological mechanisms of HFpEF may provide potential targets for its management. Diastolic dysfunction often precedes the progression to HFpEF (2). Abnormalities in aortic function contribute to diastolic dysfunction in non-RA populations (3,4).

Objectives
The aim of this study was to determine whether impaired aortic function is associated with left ventricular diastolic dysfunction in RA.

Methods
Arterial function was determined by applanation tonometry using SphygmoCor software and left ventricular diastolic function was assessed by echocardiography in 176 patients with RA. Markers of arterial function included carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification and the magnitude and timing of the forward and reflected waves. Markers of diastolic function included the ratio of early-to-late transmitral blood flow velocity (E/A), the ratio of E to the mean of the lateral and septal wall myocardial tissue lengthening at the mitral annulus (e’)(E/e’) and the septal and lateral e’. Relationships of comprehensively evaluated arterial function with markers of LV diastolic function were determined in confounder adjusted multivariate regression models.

Results
The timing of the forward (Ft) and reflected (Rt) waves were each associated with E/A (Ft: partial r=0.20, p=0.02; Rt: partial r=0.30, p=0.001) and Rt was further associated with lateral e’ (partial r=0.36, p<0.0001) and septal e’ (partial r=0.36, p<0.0001); PWV was associated with E/e’ (partial r=0.18; p=0.03). Reflected wave timing was associated with two indices of impaired relaxation (E/A<0.8: OR (95% CI)=0.51 (0.29-0.91), p=0.01; lateral e’<10: OR (95% CI)=0.43 (0.26-0.71), p=0.001); PWV was associated with an increased left ventricular filling pressure (E/e’>12: OR (95% CI)=1.58 (1.04-2.38), p=0.03).

Conclusions
Aortic stiffness and time to wave reflection are associated with increased filling pressure and impaired relaxation of the left ventricle, respectively. The development of diastolic dysfunction in RA may be partly mediated by changes in large artery function.

References
[1] Davis JM, Roger VL, Crowson CS, et al. The presentation and outcome of heart failure in patients with rheumatoid arthritis differs from that in the general population. Arthritis Rheumatol 2008;58:2603-11. [2] Aurigemma GP, Gottdiener JS, Shemanski L, et al. Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study. J Am Coll Cardiol 2001;37:1042-8.
[3] Peterson VR, Woodiwiss AJ, Libhaber CD, et al. Cardiac diastolic dysfunction is associated with aortic wave reflection, but not stiffness in a predominantly young-to-middle-aged community sample. Am J Hypertens 2016;29:1148-57.
[4] Cauwenberghs N, Knez J, Tikhonoff V, et al. Doppler indexes of left ventricular systolic and diastolic function in relation to the arterial stiffness in a general population. J Hypertens 2016;34:762-71.

Disclosure of Interest
None declared

Full text

disease activity in RA, although the effect of the other antibiotics on disease activ-
ity should be examined.
REFERENCES:
[1] Roszyk E, Puszczewicz M. Role of human microbiome and selected bacte-
rial infections in the pathogenesis of rheumatoid arthritis. Reumatologia
2017;55:242-50.
[2] Galli M, Antinori S, Atzeni F, et al. Recommendations for the management
of pulmonary fungal infections in patients with rheumatoid arthritis. Clin
Exp Rheumatol 2017;35:1018-28.
[3] Harigai M, Koike R, Miyasaka N, et al. Pneumocystis pneumonia associ-
ated with infliximab in Japan. N Engl J Med 2007;357:1874-6.
Acknowledgements: None.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2018-eular.2693
SAT0124 AORTIC STIFFNESS AND TIME TO WAVE REFLECTION
ARE ASSOCIATED WITH LEFT VENTRICULAR
DIASTOLIC DYSFUNCTION MEASURES IN
RHEUMATOID ARTHRITIS
A. M. Millen
1
, L. Mokotedi
1
,S.Gunter
1
,C.Robinson
1
, F. Michel
1
, A. J. Woodiwiss
1
,
L. Tsang
1
,G.R.Norton
1
, P. H. Dessein
2
.
1
School of Physiology, University of the
Witwatersrand, Parktown, Johannesburg, South Africa;
2
Free University Brussels,
Brussels, Belgium
Background: Patients with rheumatoid arthritis (RA) experience an increased
frequency of heart failure with a preserved ejection fraction (HFpEF) (1). The treat-
ment of HFpEF is currently suboptimal. Elucidation of the underlying pathophysio-
logical mechanisms of HFpEF may provide potential targets for its management.
Diastolic dysfunction often precedes the progression to HFpEF (2). Abnormalities
in aortic function contribute to diastolic dysfunction in non-RA populations (3,4).
Objectives: The aim of this study was to determine whether impaired aortic func-
tion is associated with left ventricular diastolic dysfunction in RA.
Methods: Arterial function was determined by applanation tonometry using
SphygmoCor software and left ventricular diastolic function was assessed by
echocardiography in 176 patients with RA. Markers of arterial function included
carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure,
pulse pressure amplification and the magnitude and timing of the forward and
reflected waves. Markers of diastolic function included the ratio of early-to-late
transmitral blood flow velocity (E/A), the ratio of E to the mean of the lateral and
septal wall myocardial tissue lengthening at the mitral annulus (e’)(E/e’) and the
septal and lateral e’. Relationships of comprehensively evaluated arterial function
with markers of LV diastolic function were determined in confounder adjusted mul-
tivariate regression models.
Results: The timing of the forward (Ft) and reflected (Rt) waves were each asso-
ciated with E/A (Ft: partial r=0.20, p=0.02; Rt: partial r=0.30, p=0.001) and Rt was
further associated with lateral e’(partial r=0.36, p<0.0001) and septal e’(partial
r=0.36, p<0.0001); PWV was associated with E/e’(partial r=0.18; p=0.03).
Reflected wave timing was associated with two indices of impaired relaxation (E/
A<0.8: OR (95% CI)=0.51 (0.29-0.91), p=0.01; lateral e’<10: OR (95% CI)=0.43
(0.26-0.71), p=0.001); PWV was associated with an increased left ventricular fill-
ing pressure (E/e’>12: OR (95% CI)=1.58 (1.04-2.38), p=0.03).
Conclusions: Aortic stiffness and time to wave reflection are associated with
increased filling pressure and impaired relaxation of the left ventricle, respectively.
The development of diastolic dysfunction in RA may be partly mediated by
changes in large artery function.
REFERENCES:
[1] Davis JM, Roger VL, Crowson CS, et al. The presentation and outcome of
heart failure in patients with rheumatoid arthritis differs from that in the
general population. Arthritis Rheumatol 2008;58:2603-11.
[2] Aurigemma GP, Gottdiener JS, Shemanski L, et al. Predictive value of sys-
tolic and diastolic function for incident congestive heart failure in the eld-
erly: the cardiovascular health study. J Am Coll Cardiol 2001;37:1042-8.
[3] Peterson VR, Woodiwiss AJ, Libhaber CD, et al. Cardiac diastolic dysfunc-
tion is associated with aortic wave reflection, but not stiffness in a predomi-
nantly young-to-middle-aged community sample. Am J Hypertens
2016;29:1148-57.
[4] Cauwenberghs N, Knez J, Tikhonoff V, et al. Doppler indexes of left ven-
tricular systolic and diastolic function in relation to the arterial stiffness in a
general population. J Hypertens 2016;34:762-71.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2018-eular.5090
SAT0125 THE IMPACT OF SELECTED COMORBIDITIES ON
TREATMENT OUTCOME IN PATIENTS WITH
RHEUMATOID ARTHRITIS: AN EXPLORATORY COHORT
STUDY.
A. Emamifar
1
, I. M. Jensen Hansen
2
.
1
Faculty of Health Sciences, University of
Southern Denmark, Odense;
2
Rheumatology, OUH, Svendborg Hospital,
Svendborg, Denmark
Background: Patients with Rheumatoid Arthritis (RA) may present with various
comorbidities resulting in worse treatment response.[1-2]
Objectives: To investigate the impact of selected comorbid diseases on RA out-
come with the aim of Disease Activity Score in 28 joints-C-Reactive Protein
(DAS28-CRP).
Methods: All our RA patients were included in this study. Patients’demographics,
serology results and DAS28-CRP at the time of diagnosis and after 4 months of
treatment initiation were collected. Patients’electronic hospital records were eval-
uated for a positive history of thyroid diseases, Diabetes Mellitus (DM), primary
hyperparathyroidism, vitamin B12 deficiency and presence of other diagnosed
autoimmune diseases.
Results: 1035 RA patients were included. 63.4% were female, mean of age 67.1
years, mean of disease duration 9.6 years, 58.6% rheumatoid factor positive and
51.3% anti-cyclic citrullinated peptide positive. The observed prevalence of thy-
roid diseases was 11.8%, DM 10.4%, primary hyperparathyroidism 2.8%, vitamin
B12 deficiency 5.8%, and other diagnosed autoimmune diseases 1.6%. There
were significant associations between presence of thyroid diseases and female
gender (p<0.001); DM and greater age (p<0.001); primary hyperparathyroidism
and longer disease duration (p=0.002); other diagnosed autoimmune diseases
and antinuclear antibody positivity (p<0.001). RA patients with thyroid diseases
(p=0.001) and other comorbid autoimmune diseases (p<0.001) had significantly
poorer initial response to the RA treatment compared to patients with isolated RA.
Univariate analyses revealed that age, presence of thyroid diseases, presence of
other diagnosed autoimmune diseases and DAS28-CRP at the time of diagnosis
were significantly associated with ΔDAS28-CRP. Additionally, multivariate analy-
sis demonstrated that ΔDAS28-CRP deterioration was significantly correlated to
the presence of thyroid diseases (unstandardized regression coefficient (standard
error);-0.188(0.088),p=0.030) and presence of other diagnosed autoimmune dis-
eases (-0.537(0.208),p=0.010). (table1)
Table 1. Univariate and multivariate analysis of risk factors for ΔDAS28-CRP.
Variables Univariate
analysis
Multivariate
analysis
Backward
analysis
Gender 0.028 (0.066) 0.058 (0.056)
Age 0.007 (0.002)** 0.003 (0.002)
Disease
duration
0.000 (0.003) - 0.003 (0.003)
IgM- rheumatoid
factor
-0.055 (0.065) 0.014 (0.068)
Anti-
cyclic
citrullinated
peptide
antibody
-0.098 (0.065) -0.041 (0.068)
Antinuclear
antibody
0.003 (0.086) -0.042 (0.067)
Presence of
Thyroid
diseases
-0.315 (0.098)** -0.188 (0.088)* -
0.160 (0.081)*
Presence of
Primary
Hyperparathyroidism-0.059 (0.193)0.008 (0.159)Presence of Diabetes Mellitus0.077 (0.104)-
0.023 (0.086)Presence of vitamin B12 deficiency0.102 (0.136)0.047 (0.112)Presence of
other diagnosed autoimmune diseases-0.895 (0.249)**-0.537 (0.208)*-0.565 (0.204)*Thyroid
stimulating hormone level0.013 (0.008)0.011 (0.007)DAS28-CRP at time of diagnosis0.724
(0.027)**0.711 (0.029)**0.715 (0.029)***P value <0.05, ** P value <0.005
Conclusions: RA patients are at increased risk of specific comorbidities with pos-
sible impact on the treatment outcome. The authors, therefore, recommend to do
periodical assessment of comorbidities to diagnose concurrent comorbid dis-
eases as early as possible.
REFERENCES:
[1] Emamifar A, et al. Thyroid disorders in patients with newly diagnosed
rheumatoid arthritis is associated with poor initial treatment response eval-
uated by disease activity score in 28 joints-C-reactive protein (DAS28-
CRP): An observational cohort study. Medicine (Baltimore) 2017;96:e8357.
[2] Emamifar A, et al. Patients with newly diagnosed Rheumatoid Arthritis are
at increased risk of Diabetes Mellitus: An Observational Cohort study. Acta
Reumatol Port 2017 [Epub ahead of print].
924 Saturday, 16 June 2018 Scientific Abstracts
on February 5, 2021 by guest. Protected by copyright.http://ard.bmj.com/Ann Rheum Dis: first published as 10.1136/annrheumdis-2018-eular.5090 on 12 June 2018. Downloaded from